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Catherine Gutfreund, Sonoma County Medical Association president, on Medicare, other issues

[caption id="attachment_23341" align="alignleft" width="144" caption="Catherine Gutfreund, M.D."][/caption]

SANTA ROSA — The Sonoma County medical community faces a range of challenges, from artificially low Medicare reimbursements, to retaining top physicians, to a growing amount of uninsured patients and concerns about rising childhood obesity.

To get a sense on what is being done to address the issues, the Business Journal recently spoke with Catherine Gutfreund, a family medicine physician at Kaiser Permanente Medical Center Santa Rosa, who just recently took the helm for the next year as president of the Sonoma County Medical Association, which has over 600 physician members.

Dr. Gutfreund has been with Kaiser for the past six years. Previously, she was in private practice for another six years; she’s served as a board member of the medical association for the past eight years.

Business Journal: From a physician’s standpoint, how severely impacted is Sonoma County by its designation as a “rural” county versus and “urban” county?

Dr. Gutfreund: Medicare reimbursement is a major issue for Sonoma County. The cost of running a business in Sonoma County is as expensive as surrounding counties that are reimbursed at a 10 percent higher rate. These statistics could deter physicians from starting a private practice here, and also have caused many physicians to leave Sonoma County. It makes it very difficult for physicians in private practice or small groups to remain viable. That’s why a lot of new physicians are coming to Sutter or Kaiser, so they can work. I left private practice because of the stability, and I really like the preventative care and integrated health model Kaiser has. Essentially, in Sonoma County, we’re about as urban as Marin, but we’re paid 10 percent less. So reimbursements are less for Medicare and insurers base payment off Medicare rates. It really hurts physicians.

Business Journal: What is the Medical Association doing to change the rate?

Dr. Gutfreund: We’re continuously working with the California Medical Association with legislative issues that come up. Getting physician reimbursements higher is a priority. By 2012, Medicare reimbursement rates will be cut by 30 percent, and that’s unsustainable.

Business Journal: What are some of the main health issues affecting Sonoma County right now?

Dr. Gutfreund: One of the biggest is obesity; probably that’s the biggest in Sonoma County. It leads to multiple chronic illnesses that are preventable and every-day common things like joint and knee pain. And just by modifying lifestyle, a significant number of these diseases can be prevented. Childhood obesity is really on the rise – 36 percent of people are overweight in America, and 30 percent of those are obese. Ten to 20 percent of kids are obese these days. So we need things like bikeways that encourage physical exercise. Here in Sonoma County, we’re trying to get business leaders and others to walk, through county programs like iWalk and be healthy. iGrow is trying to get healthy and local food in the mix.

Business Journal: What are some other health issues?

Dr. Gutfreund: Currently the lack of immunizations and the personal belief exemptions for getting kids into schools. We have the most lax immunization wavers in the state, and maybe the country. The California state average is 94 percent of children entering kindergarten are fully immunized, but in Sonoma County it’s 88 percent. Some of the districts in West County are less than 60 percent immunized when entering school. We’re having an epidemic on whooping cough. Last year, there were four cases in the county, and this year there have been 48 cases, and our county has the lowest percentage of kids immunized for all shots. This leads to unnecessary disease and possibly death. Some people feel their child will develop an auto immune deficiency or autism as a result of immunizations.  There’s always a risk, but the benefits always outweigh the risk, and no children should die from a disease that we can eradicate.

Business Journal: Sutter Health is trying to build a new hospital, and to do so needs to meet certain health care needs of the Health Care Access Agreement with the county. What’s your take on the newly proposed plan by Sutter?

Dr. Gutfreund: According to the new plan they submitted, I think they will be fulfilling the Health Care Access Agreement that was instituted in 1996. I think the new hospital is definitely needed because of the seismic requirements. The county supervisors will make sure the new Sutter is accessible. The plan (Sutter) had in the past had some questions, but I think the new plan meets requirements plus some.

Business Journal: Many of Sonoma County’s independent hospitals have struggled in the recent past. What are some ways to ensure their success and how important is their overall role?

Dr. Gutfreund: One of the advantages of district hospitals is that they create a lot of local jobs, especially out further in West County. But they’re dependent on patient volume, and a lot of the patients that tend to go to district hospitals don’t have insurance. The smaller hospitals aren’t able to get the same insurance rates and Medcare reimbursements rates as a Sutter – and that’s a major problem. Not only are they reimbursed less, but also their patient population tends to be uninsured.

The Northern California Health Care Authority is a good example of what can be done. Palm Drive, Sonoma Valley Hospital and Mendocino – they can have more negotiating power with insurance companies to get higher reimbursement rates, and it avoids anti-trust laws. (The Sonoma Medical Association) has multiple physicians and board members that are working with all of the coalitions in the county – including the clinics, which are vital as more people get health insurance.

Sonoma County has one of the highest, if not the highest, participation rates in physician members in the state, which is great. The more voice you have the more powerful you are.